Background: Hypertension is a lifestyle-related disease that has no subjective symptoms but could lead to severe complications. The goals of treatment for hypertension are to maintain blood pressure with medications and prevent complications. Measuring blood pressure at home regularly is critical for patients with hypertension. Purpose: This study aimed to 1) clarify the status of patients’ understanding of hypertension and self-management, 2) identify nursing practices that could support patients with hypertension in making them aware of the need for understanding hypertension, monitoring blood pressure at home, and engaging in self-management. Method: A questionnaire survey on understanding of the disease and self-management behavior was conducted among patients with hypertension who regularly visited outpatient clinics. As for data analysis, descriptive statistics were computed for patients’ attributes, clinical findings, understanding of the disease, and self-management behavior. Cross-tabulation and the chi-square test were used for each item on understanding of the disease and self-management behaviors. Results: Data were obtained from 150 participants (93 males and 57 females) with a mean age of 70 years. Patients with a higher understanding of the disease and those who were aware of the target blood pressure were more likely to engage in self-management behavior, including monitoring blood pressure at home, ensuring regular outpatient visits, and consulting with nurses or physicians. In addition, the percentage of patients who recognized the need to achieve their target blood pressure was higher among those who had a spouse and lived with their family. Discussion: Regular monitoring and recording of blood pressure at home are the most important self-management behaviors. Understanding of the disease and self-management behavior and support from the family are critical for maintaining appropriate self-management. Therefore, in cooperation with physicians, nurses should provide health education to patients and their families to enable them to perform appropriate self-management. Health expenditures increase with age, especially in those aged 65 years and over. The prevalence of hypertension increases with age; patients aged 65 years and over need to engage in self-management to maintain their target blood pressure. Nurses should provide patients with hypertension aged 65 years and over with appropriate nursing care to enable them to measure and record their blood pressure at home appropriately and regularly. Appropriate nursing care may help reduce the health expenditure. This may help reduce the health expenditure.
Hypertension is a lifestyle-related disease, and its prevalence increases with age. Hypertension is also known as a “silent killer” because severe complications can develop in the absence of subjective symptoms. High blood pressure increases the risk of onset of diseases such as coronary artery disease, cardiovascular system disorders, and cerebrovascular disorder, as well as the risk of mortality [
The Japanese Society of Hypertension (JSH) published Guidelines for the Management of Hypertension 2014, which suggest the usefulness of monitoring blood pressure at home in improving the treatment continuation rate and evaluating if antihypertensive medications have been insufficiently or overly effective in reducing blood pressure as prescribed [
Previous studies reported that blood pressure measurements from home are better predictors of the prognosis or onset of cardiovascular diseases as compared to the measurement of blood pressure during medical examinations [
The present study aimed to 1) clarify the status of patients’ understanding of hypertension and self-management, 2) identify nursing practices that could support patients with hypertension in making them aware of the need for understanding hypertension, monitoring blood pressure at home, and engaging in self-management.
1) Study period: April 1 to September 30, 2015.
2) Study site: The outpatient clinic of the Department of Cardiology at Tokyo Medical University Hospital.
3) Participants: Patients with hypertension who visited the outpatient cardiology clinic regularly Selection criteria of the participants were as follows: outpatients were diagnosed with hypertension, who regularly booked their next appointment and visited the hospital for follow-up examinations. Subjects were defined as patients with hypertension who regularly visited the outpatient cardiology clinic.
4) Study context
a) Background of participants
Sex, age, duration of disease, presence or absence of taking antihypertension medications, type of antihypertension medication, blood test results, height, weight, blood pressure during medical examination.
b) Survey on understanding of the disease and self-management behavior
A questionnaire developed by the authors was used to examine participants’ understanding of the disease and self-management behavior. Items were scored on a dichotomous scale based on yes or no responses.
5) Analysis methods
Simple tabulation and descriptive analyses were used for examining patients’ basic attributes and clinical findings. Additionally, descriptive statistics were computed for participants’ understanding of the disease and self-management behavior. Cross-tabulation and the chi-square test were performed to examine each item pertaining to understanding of the disease and self-management behavior. Data were analyzed using IBM SPSS Statistics Ver.24.
This study was approved by the Ethics Review Committee of the School of Nursing at Tokyo Medical University and Tokyo Medical University Hospital. The researcher orally explained the research objectives and participation details using instructions sheets to each participant. They were informed that participation in the study was voluntary and that they could withdraw consent at any time, even after agreeing to participate. They would receive no disadvantage as a result of leaving the study. It was also explained that personal information would be protected, that the research data would not be used for anything other than for the present study, and that all the data collected would be shredded after the completion of the study. Subsequently, those who agreed to participate in the study signed the consent form and completed the questionnaire. The survey was anonymous and participants did not need to fill in the questions they did not want to answer. The patients were asked to place the completed questionnaire in a collection box after completing their medical examination at the outpatient clinic.
Data were obtained from 150 participants (93 males and 57 females). The mean age was 70 ± 10.6 years, with a range of 46 - 92 years. The participants’ educational level was distributed as follows: middle school: 16 (10.7%), high school: 49 (32.7%), college/vocational school: 26 (17.3%), and undergraduate/graduate school: 58 (38.7%). Further, 72 participants currently employed, and among them, 35 participants (38.7%) were categorized as “office worker/public officials/staff member of association/teachers,” 27 (18%) as “runs private company/freelance business/small business,” 1 participant (0.7%) as “engaged in agricultural/fishing industry,” and 9 participants (6%) as “work part-time job.” Additionally, 120 participants (80%) were married, 30 (20%) lived by themselves, and 120 (80%) lived with their family.
The average disease duration was 8.4 ± 5.8 years. All participants took antihypertension medications and the average number of medications prescribed per participant was 2.1 ± 1. The average systolic and diastolic blood pressures were 139.1 ± 18.1 mmHg and 74.6 ± 13 mmHg, respectively. The average body mass index (BMI) was 26.4 ± 4 kg/m2. Further, 91 (60.7%) reported that they had a drinking habit, while 59 (39.3%) reported that they did not have a drinking habit. Regarding smoking status, 20 (13.3%) participants currently smoked, 63 (45.3%) had smoked previously, and 62 (41.4%) had never smoked. The average blood test results were as follows: total cholesterol level, 185.2 ± 36.9 mg/dl; triglycerides level, 144.6 ± 74.9 mg/dl; high-density lipoprotein (HDL) cholesterol level, 50.1 ± 13.6 mg/dl; low-density lipoprotein (LDL) cholesterol, 96.4 ± 27 mg/dl; urea nitrogen level, 16.1 ± 4.6 mg/dl; creatinine level, 1.5 ± 8.4 mg/dl; uric acid level, 5.7 ± 1.3 mg/dl; sodium level, 142 ± 3.8 mEq/L; potassium level, 4.4 ± 3.5 mEq/L; chlorine level, 105.9 ± 2.4 mEq/L; blood glucose level, 119.4 ± 36 mg/dl; HbA1c level, 6.2% ± 0.9% (
For the question “Do you know what hypertension is?”, 135 (90%) participants answered “I do” and 15 (10%) answered, “I don’t.” For the question “Do you know the risk factors that exacerbate hypertension?”, 125 (83.4%) answered “I do” and 25 (16.6%) answered “I don’t.” For the question “Do you know the complications that can occur due to hypertension?”, 118 (78.7%) participants
Age | 70.0 ± 10.6 |
---|---|
Gender n (%) | |
Male | 93 (62%) |
Female | 57 (38%) |
Disease duration | 8.4 ± 5.8 |
Taking antihypertensive medicine n (%) | |
Yes | 150 (100%) |
No | 0 (0%) |
Number of antihypertensive medicine | 2.1 ± 1.0 |
Educational Level n (%) | |
Undergraduate/graduate school | 58 (38.7%) |
College/vocational school | 26 (17.3%) |
High school | 49 (32.7%) |
Middle school | 16 (10.7%) |
Employment n (%) | |
Yes | 72 (48%) |
No | 78 (52%) |
Profession n (%) | |
Office worker/public officials/staff member of association/teachers | 35 (20%) |
Runs private company/freelance business/small business | 27 (18%) |
Agricultural/fishing industry | 1 (0.7%) |
Marriage n (%) | |
Married | 120 (80%) |
Unmarried/divorce | 30 (20%) |
Living n (%) | |
Living with family | 120 (80%) |
Living alone | 30 (20%) |
Drinking habit n (%) | |
Yes | 91 (60.7%) |
No | 59 (39.3%) |
Smoking habit n (%) | |
Yes (currently) | 20 (13.3%) |
Yes (previously) | 68 (45.3%) |
No | 62 (41.4%) |
BMI (Body Mass Index) | 24.6 ± 4.0 |
Systolic Blood Pressure: SBP (mmHg) | 139.1 ± 18.1 |
Diastolic Blood Pressure: DBP (mmHg) | 74.6 ± 13.0 |
T-Cho (mg/dl) | 185.2 ± 36.9 |
TG (mg/dl) | 144.6 ± 74.9 |
HDL-C (mg/dl) | 50.1 ± 13.6 |
LDL-C (mg/dl) | 96.4 ± 27.0 |
BUN (mg/dl) | 16.1 ± 4.6 |
Cre (mg/dl) | 1.5 ± 8.4 |
UA (mg/dl) | 5.7 ± 1.3 |
Na (mEq/L) | 142 ± 3.8 |
K (mEq/L) | 4.4 ± 3.5 |
Cl (mEq/L) | 105.9 ± 2.4 |
BS (mg/dl) | 119.4 ± 36.0 |
HbA1c (%) | 6.2 ± 0.9 |
answered “I do” and 32 (21.3%) answered “I don’t.” For the question “Do you know the symptoms of high blood pressure?”, 104 (69.3%) answered “I do” and 46 (30.7%) answered “I don’t.” For the question “Do you know the need for reconsidering your lifestyle?”, 127 (84.7%) answered “I do” and 23 (15.3%) answered “I don’t.” For the question “Do you know the types of prescribed drugs and their effects?”, 120 (80%) answered “I do” and 30 (20%) answered “I don’t.” (
For the question “Do you have your own sphygmomanometer?”, 142 (94.7%) answered “I do” and 8 (5.3%) answered “I don’t.” For the question “Do you measure your blood pressure at home?”, 117 (78%) answered “I do” and 33 (22%) answered “I don’t.” For the question “Do you record your blood pressure in a notebook?”, 91 (60.7%) answered “I do” and 59 (39.3%) answered “I don’t.” For the question “Do you know the appropriate blood pressure?”, 140 (93.3%) answered “I do” and 10 (6.7%) answered “I don’t.” For the question “Do you visit your physicians as scheduled?”, 149 (99.3%) answered “I do” and 1 (0.7%) answered “I don’t.” For the question “Do you show your blood pressure records to your physicians during the medical examination?”, 67 (44.6%) answered “I do” and 83 (55.4%) answered “I don’t.” For the question “Do you consult with physicians or nurses?”, 131 (87.3%) answered “I do” and 19 (12.7%) answered “I don’t.” (
1) Understanding of each item on knowledge of disease/understanding of disease and self-management behaviors
Frequency | (%) | ||
---|---|---|---|
Do you know what hypertension is? | I do | 135 | 90.0% |
I don’t | 15 | 10.0% | |
Do you know the risk factors that exacerbate hypertension? | I do | 125 | 83.4% |
I don’t | 25 | 16.6% | |
Do you know the complications that can occur due to hypertension? | I do | 118 | 78.7% |
I don’t | 32 | 21.3% | |
Do you know the symptoms of high blood pressure? | I do | 104 | 69.3% |
I don’t | 46 | 30.7% | |
Do you know the need for reconsidering your lifestyle? | I do | 127 | 84.7% |
I don’t | 23 | 15.3% | |
Do you know the types of prescribed drugs and their effects? | I do | 120 | 80.0% |
I don’t | 30 | 20.0% |
Frequency | (%) | ||
---|---|---|---|
Do you have your own sphygmomanometer? | I do | 142 | 94.7% |
I don’t | 8 | 5.3% | |
Do you measure your blood pressure at home? | I do | 117 | 78.0% |
I don’t | 33 | 22.0% | |
Do you record your blood pressure in a notebook? | I do | 91 | 60.7% |
I don’t | 59 | 39.3% | |
Do you know the appropriate blood pressure? | I do | 140 | 93.3% |
I don’t | 10 | 6.7% | |
Do you visit your physician as scheduled? | I do | 149 | 99.3% |
I don’t | 1 | 0.7% | |
Do you show your blood pressure records to your physician during the medical examination? | I do | 67 | 44.6% |
I don’t | 83 | 55.4% | |
Do you consult with physicians or nurses? | I do | 131 | 87.3% |
I don’t | 19 | 12.7% |
Understanding of the disease (7 items) and self-management behaviors (5 items) were cross-tabulated (
a) Understanding of hypertension and self-management behavior
When examining the association between “understanding of hypertension” and “recording blood pressure,” participants who reported “yes” to the former had a significantly higher percentage of recording their blood pressure (94.5%, adjusted residual = 2.2). Pertaining to “showing the records to physicians at a medical examination,” participants who reported that they had an understanding of hypertension had a significantly higher percentage of showing the records
Understanding of knowledge/understanding of disease | Self-management behavior | |||
---|---|---|---|---|
Measuring blood pressure at home | Recording blood pressure | Showing the records to physicians during medical examination | Consulting with physicians or nurses | |
Understanding of hypertension | Asymptotic significance probability (0.027) X2 (2) = 4.882 | Asymptotic significance probability (0.026) X2 (2) = 4.973 | Asymptotic significance probability (0.000) X2 (2) = 18.785 | |
Understanding of the risk factors that exacerbate hypertension | Asymptotic significance probability (0.001) X2 (2) = 11.818 | Asymptotic significance probability (0.028) X2 (2) = 4.846 | Asymptotic significance probability (0.034) X2 (2) = 4.480 | Asymptotic significance probability (0.000) X2 (2) = 11.222 |
Understanding of complications led to by hypertension | Asymptotic significance probability (0.022) X2 (2) = 5.243 | Asymptotic significance probability (0.022) X2 (2) = 5.243 | Asymptotic significance probability (0.000) X2 (2) = 14.099 | |
Understanding of subjective symptoms when experiencing high blood pressure | Asymptotic significance probability (0.000) X2 (2) = 14.408 | Asymptotic significance probability (0.002) X2 (2) = 9.279 | ||
The necessity of reconsidering lifestyle | Asymptotic significance probability (0.007) X2 (2) = 7.303 | Asymptotic significance probability (0.042) X2 (2) = 4.141 | Asymptotic significance probability (0.000) X2 (2) = 18.737 | |
Understanding of prescribed medications | Asymptotic significance probability (0.000) X2 (2) = 13.296 | Asymptotic significance probability (0.034) X2 (2) = 4.478 | ||
Understanding of target blood pressure | Asymptotic significance probability (0.003) X2 (2) = 9.016 | |||
p < 0.05, versus each respective countenrparts |
(95.5%, adjusted residual = 2.2). Pertaining to “consulting with physicians or nurses,” those who that they had an understanding of hypertension had a significantly higher percentage of consulting with physicians or nurses (93.9%, adjusted residual = 4.3, P = 0.000) (
b) Understanding the risk factors that exacerbate hypertension and self-management behavior
Among those who understood the risk factors that exacerbate hypertension, a significantly higher percentage reported measuring their blood pressure at home (88.9%, adjusted residual = 3.4), recording their blood pressure (92.3%, adjusted residual = 2.2), showing the records to the physicians during a medical examination (89.6%, adjusted residual = 2.1), and consulting with physicians or nurses (87%, adjusted residual = 3.3) (
c) Understanding of complications caused by hypertension and self-management behavior
Among those who understood the complications caused by hypertension, a significantly higher percentage reported measuring blood pressure at home
Recording blood pressure | X2 Test | |||
---|---|---|---|---|
Understanding of hypertension | Yes | No | ||
Yes | frequency (%) | 86 (94.5%) | 21 (80.8%) | P = 0.027 |
adjusted residual | 2.2 | −2.2 | ||
No | frequency (%) | 5 (5.5%) | 5 (19.2%) | |
adjusted residual | −2.2 | 2.2 | ||
Showing the records to physician at a medical examination | X2 Test | |||
Understanding of hypertension | Yes | No | ||
Yes | frequency (%) | 64 (95.5%) | 63 (84%) | P = 0.026 |
adjusted residual | 2.2 | −2.2 | ||
No | frequency (%) | 3 (4.5%) | 12 (16%) | |
adjusted residual | −2.2 | 2.2 | ||
Consulting with physicians or nurses | X2 Test | |||
Understanding of hypertension | Yes | No | ||
Yes | frequency (%) | 123 (93.9%) | 11 (61.1%) | P = 0.000 |
adjusted residual | 4.3 | −4.3 | ||
No | frequency (%) | 8 (6.1%) | 7 (38.9%) | |
adjusted residual | −4.3 | 4.3 |
Measuring blood pressure at home | X2 Test | |||
---|---|---|---|---|
Understood the risk factors that exacerbate hypertension | Yes | No | ||
Yes | frequency (%) | 104 (88.9%) | 21 (63.6%) | P = 0.001 |
adjusted residual | 3.4 | −3.4 | ||
No | frequency (%) | 13 (11.1%) | 12 (36.4%) | |
adjusted residual | −3.4 | 3.4 | ||
Recording blood pressure | X2 Test | |||
Understood the risk factors that exacerbate hypertension | Yes | No | ||
Yes | frequency (%) | 84 (92.3%) | 20 (76.9%) | P = 0.028 |
adjusted residual | 2.2 | −2.2 | ||
No | frequency (%) | 7 (7.7%) | 6 (23.1%) | |
adjusted residual | −2.2 | 2.2 | ||
Showing the records to physicians at a medical examination | X2 Test | |||
Understood the risk factors that exacerbate hypertension | Yes | No | ||
Yes | frequency (%) | 60 (89.6%) | 57 (76%) | P = 0.034 |
adjusted residual | 2.1 | −2.1 | ||
No | frequency (%) | 7 (10.4%) | 18 (24%) | |
adjusted residual | −2.1 | 2.1 | ||
Consulting with physicians or nurses | X2 Test | |||
Understood the risk factors that exacerbate hypertension | Yes | No | ||
Yes | frequency (%) | 114 (87%) | 10 (55.6%) | P = 0.001 |
adjusted residual | 3.3 | −3.3 | ||
No | frequency (%) | 17 (13%) | 8 (44.4%) | |
adjusted residual | −3.3 | 3.3 |
(82.9%, adjusted residual = 2.4), showing the records to their physicians during medical examinations (88.6%, adjusted residual = 2.3), and consulting with physicians or nurses (83.2%, adjusted residual = 3.8) (
d) Understanding of subjective symptoms of high blood pressure and self-management behavior
Among those who understood symptoms of high blood pressure, a significantly higher percentage reported measuring blood pressure at home (76.9%, adjusted residual = 3.8) and consulting with physicians or nurses (74%, adjusted residual = 3.0) (
e) Understanding of the need for reconsidering lifestyle and self management behavior
Among those who understood the need for reconsidering their lifestyle, a significantly higher percentage reported measuring blood pressure at home (88.9%, adjusted residual = 2.7), showing their records to their physicians during medical examinations (91%, adjusted residual = 2.0), and consulting with physicians or nurses (89.3%, adjusted residual = 4.3) (
f) Understanding of prescribed medications and self-management behavior
Among those who understood prescribed medications, a significantly higher percentage reported measuring blood pressure at home (86.3%, adjusted residual = 3.6) and consulting with physicians or nurses (82.4%, adjusted residual =
Measuring blood pressure at home | X2 Test | |||
---|---|---|---|---|
Understood the complications caused by hypertension | Yes | No | ||
Yes | Frequency (%) | 97 (82.9%) | 21 (63.6%) | P = 0.022 |
Adjusted residual | 2.4 | −2.4 | ||
No | Frequency (%) | 20 (17.1%) | 12 (36.4%) | |
Adjusted residual | −2.4 | 2.4 | ||
Showing the records to physicians at a medical examination | X2 Test | |||
Understood the complications caused by hypertension | Yes | No | ||
Yes | Frequency (%) | 58 (86.6%) | 53 (70.7%) | P = 0.022 |
Adjusted residual | 2.3 | −2.3 | ||
No | Frequency (%) | 9 (13.4%) | 22 (29.3%) | |
Adjusted residual | −2.3 | 2.3 | ||
Consulting with physicians or nurses | X2 Test | |||
Understood the complications caused by hypertension | Yes | No | ||
Yes | Frequency (%) | 109 (83.2%) | 8 (44.4%) | P = 0.000 |
Adjusted residual | 3.8 | −3.8 | ||
No | Frequency (%) | 22 (16.8%) | 10 (55.6%) | |
Adjusted residual | −3.8 | 3.8 |
Measuring blood pressure at home | X2 Test | |||
---|---|---|---|---|
Understanding of subjective symptoms of high blood pressure | Yes | No | ||
Yes | Frequency (%) | 90 (76.9%) | 14 (42.4%) | P = 0.000 |
Adjusted residual | 3.8 | −3.8 | ||
No | Frequency (%) | 27 (23.1%) | 19 (57.6%) | |
Adjusted residual | −3.8 | 3.8 | ||
Consulting with physicians or nurses | X2 Test | |||
Understanding of subjective symptoms of high blood pressure | Yes | No | ||
Yes | Frequency (%) | 97 (74%) | 7 (38.9%) | P = 0.002 |
Adjusted residual | 3 | −3 | ||
No | Frequency (%) | 34 (26%) | 11 (61.1%) | |
Adjusted residual | −3 | 3 |
Measuring blood pressure at home | X2 Test | |||
---|---|---|---|---|
Understanding of the need for reconsidering lifestyle | Yes | No | ||
Yes | Frequency (%) | 104 (88.9%) | 23 (69.7%) | P = 0.007 |
Adjusted residual | 2.7 | −2.7 | ||
No | Frequency (%) | 13 (11.1%) | 10 (30.3%) | |
Adjusted residual | −2.7 | 2.7 | ||
Showing the records to physicians at a medical examination | X2 Test | |||
Understanding of the need for reconsidering lifestyle | Yes | No | ||
Yes | Frequency (%) | 61 (91%) | 59 (78.7%) | P = 0.042 |
Adjusted residual | 2 | −2 | ||
No | Frequency (%) | 6 (9%) | 16 (21.3%) | |
Adjusted residual | −2 | 2 | ||
Consulting with physicians or nurses | X2 Test | |||
Understanding of the need for reconsidering lifestyle | Yes | No | ||
Yes | Frequency (%) | 117 (89.3%) | 9 (50%) | P = 0.000 |
Adjusted residual | 4.3 | −4.3 | ||
No | Frequency (%) | 14 (10.7%) | 9 (50%) | |
Adjusted residual | −4.3 | 4.3 |
2.1). (
g) Understanding of target blood pressure and self-management behavior
Among those who understood target blood pressure, a significantly higher percentage reported measuring blood pressure at home (96.6%, adjusted residual = 3.0) (
Measuring blood pressure at home | X2 Test | |||
---|---|---|---|---|
Understanding of prescribed medications | Yes | No | ||
Yes | Frequency (%) | 101 (86.3%) | 19 (57.6%) | P = 0.000 |
Adjusted residual | 3.6 | −3.6 | ||
No | Frequency (%) | 16 (13.7%) | 14 (42.4%) | |
Adjusted residual | −3.6 | 3.6 | ||
Consulting with physicians or nurses | X2 Test | |||
Understanding of prescribed medications | Yes | No | ||
Yes | Frequency (%) | 108 (82.4%) | 11 (61.1%) | P = 0.034 |
Adjusted residual | 2.1 | −2.1 | ||
No | Frequency (%) | 23 (17.6%) | 7 (38.9%) | |
Adjusted residual | −2.1 | 2.1 |
Measuring blood pressure at home | X2 Test | |||
---|---|---|---|---|
Understanding of target blood pressure | Yes | No | ||
Yes | Frequency (%) | 113 (96.6%) | 27 (81.8%) | P = 0.003 |
Adjusted residual | 3 | −3 | ||
No | Frequency (%) | 4 (3.4%) | 6 (18.2%) | |
Adjusted residual | −3 | 3 |
2) Basic attributes of participants and their understanding of the disease, and self-management behavior
Cross-tabulation was performed between the basic attributes of participants and their understanding of the disease (7 items), and their self-management behaviors (5 items) (
a) Basic attributes of participants and understanding of the disease
Participants with an educational attainment level of up to middle school had a significantly higher percentage of those reporting that they did not have an understanding of the symptoms of high blood pressure (62.5%, adjusted residual = 2.9), need for reconsidering their lifestyle (43.8%, adjusted residual = 3.3), and prescribed medications (50%, adjusted residual = 3.2). Housewives/husbands had a significantly higher percentage of individuals who measured blood pressure at home (96.6%, adjusted residual = 2.7). Participants aged 65 years and
Self-management behavior Understanding of knowledge/disease | Participant background | |||
---|---|---|---|---|
Educational Level | Living (living alone/living with family) | Age | Profession | |
Understanding of subjective symptoms when experiencing high blood pressure | Asymptotic significance probability (0.013) X2 (2) = 10.7888 | |||
The necessity of reconsidering lifestyle | Asymptotic significance probability (0.007) X2 (2) = 12.202 | |||
Understanding of prescribed medications | Asymptotic significance probability (0.017) X2 (2) = 10.232 | Asymptotic significance probability (0.049) X2 (2) = 6.034 | ||
Understanding of target blood pressure | Asymptotic significance probability (0.014) X2 (2) = 6.027 | |||
Measuring blood pressure at home | Asymptotic significance probability (0.021) X2 (2) = 9.778 | Asymptotic significance probability (0.014) X2 (2) = 15.996 |
younger had a significantly higher percentage of individuals who reported understanding prescribed medications (91.1%, adjusted residual = 2.2) (
b) Basic attributes of participants and self-management behaviors
Participants who lived with their family reported a significantly higher percentage of understanding target blood pressure (95.8%, adjusted residual = 2.5) (
When considering the association between self-management behaviors and understanding of the disease, participants who measured their blood pressure at home were more likely to understand hypertension, the risk factors that exacerbate it, related complications, subjective symptoms, types and effects of prescribed medications, and the importance of lowering blood pressure to targeted values. According to the recommendations of the Guidelines for the Management of Hypertension 2014, better understanding and self-management has been achieved when physicians stress on the importance of measuring blood pressure and providing guidance at each visit for patients to measure at home
Educational Level | X2 Test | |||||
---|---|---|---|---|---|---|
Understanding of the symptoms of high blood pressure | Middle school | High school | College/vocational school | Undergraduate/ graduate school | ||
Yes | Frequency (%) | 6 (37.5%) | 33 (67.3%) | 22 (84.6%) | 42 (72.4%) | P = 0.013 |
Adjusted residual | −2.9 | −0.3 | 1.9 | 0.7 | ||
No | Frequency (%) | 10 (62.5%) | 16 (32.7%) | 4 (15.4%) | 16 (27.6%) | |
Adjusted residual | 2.9 | 0.3 | −1.9 | −0.7 | ||
Educational Level | X2 Test | |||||
Understanding of the need for reconsidering lifestyle | Middle school | High school | College/vocational school | Undergraduate/ graduate school | ||
Yes | Frequency (%) | 9 (56.3%) | 41 (83.7%) | 24 (92.3%) | 52 (89.7%) | P = 0.007 |
Adjusted residual | −3.3 | −0.2 | 1.2 | 1.4 | ||
No | Frequency (%) | 7 (43.8%) | 8 (16.3%) | 2 (7.7%) | 6 (10.3%) | |
Adjusted residual | 3.3 | 0.2 | −1.2 | −1.4 | ||
Educational Level | X2 Test | |||||
Understanding of prescribed medications | Middle school | High school | College/vocational school | Undergraduate/ graduate school | ||
Yes | Frequency (%) | 8 (50%) | 42 (85.7%) | 21 (80.8%) | 48 (82.8%) | P = 0.017 |
Adjusted residual | −3.2 | 1.2 | 0.1 | 0.7 | ||
No | Frequency (%) | 8 (50%) | 7 (14.3%) | 5 (19.2%) | 10 (17.2%) | |
Adjusted residual | 3.2 | −1.2 | −0.1 | −0.7 |
Profession | X2 Test | ||||||||
---|---|---|---|---|---|---|---|---|---|
Measuring blood pressure at home | Office worker/public officials/staff member of association/ teachers | Runs private company/ freelance business/ small business | Agricultural/ fishing industry | Part-time job | Housewife (professional)/ husband (stay home) | Unemployed | |||
Yes | Frequency (%) | 24 (68.6%) | 22 (81.5%) | 1 (100%) | 5 (55.6%) | 28 (96.6%) | 34 (81%) | P = 0.014 | |
Adjusted residual | −1.5 | 0.5 | 0.5 | −1.7 | 2.7 | 0.5 | |||
No | Frequency (%) | 11 (31.4%) | 5 (18.5%) | 0 (0%) | 4 (44.4%) | 1 (3.4%) | 8 (19%) | ||
Adjusted residual | 1.5 | −0.5 | −0.5 | 1.7 | −2.7 | −0.5 |
Age | X2 Test | ||||
---|---|---|---|---|---|
Understanding of prescribed medications | Aged 65 years or below | Early-stage elderly individuals | Late-stage elderly individuals aged 75 years or over | ||
Yes | Frequency (%) | 41 (91.1%) | 37 (71.2%) | 42 (79.2%) | P = 0.049 |
Adjusted residual | 2.2 | −2 | −0.2 | ||
No | Frequency (%) | 4 (8.9%) | 15 (28.8%) | 11 (20.8%) | |
Adjusted residual | −2.2 | 2 | 0.2 |
Living | X2 Test | |||
---|---|---|---|---|
Understanding target blood pressure | Living alone | Living with family | ||
Yes | Frequency (%) adjusted residual | 25 (83.3%) | 115 (95.8%) | P = 0.014 |
−2.5 | 2.5 | |||
No | Frequency (%) adjusted residual | 5 (16.7%) | 5 (4.2%) | |
2.5 | −2.5 |
[
In this study, many participants reported that they consulted with physicians or nurses. This may indicate that they recognized the need for understanding their disease and their physical conditions, and they were aware that it takes time to recover once the disease aggravates and that age-related changes affect their health. This result also suggests that providing health guidance thoroughly with the cooperation of physicians and nurses would further facilitate patients’ consultation with health personnel and their ability to engage in appropriate self-management behaviors. During medical examinations, physicians and nurses can evaluate the self-management situation at home through the record notebooks or consultation. They could use this information to provide words of encouragement and appreciation of patients’ efforts, and to provide positive feedback on what patients have done, which would in turn increase patients’ confidence and motivate their self-management. Thus, healthcare professionals can foster patients’ continuation of self-management and increase their self-efficacy.
Considering the association between the participants’ basic attributes and understanding of the disease, and their self-management behaviors, the present study found that participants with higher education tended to understand the disease and measure blood pressure at home. Such patients may be able to obtain information about the disease and methods of self-management more effectively, which could deepen their knowledge about the disease and self-management. Based on this knowledge, they may have a greater ability to understand and identify important self-management that match their lifestyle.
Kubota et al. analyzed lifetime risk of developing cardiovascular diseases according to educational achievement, using results of a large-scale cohort study that followed 13,948 participants for 26 years [
Participants who lived with their family were more likely to understand the need for achieving their target blood pressure. Previous studies indicated that existence and support from the family are necessary for patients to perform appropriate self-management [
In Japan, the health expenditures on hypertension were 1,798,100,000,000 JPY in 2016. Further, health expenditures increase with age, especially in those aged 65 years and over [
The Guidelines for the Management of Hypertension 2014 suggest the usefulness of measuring blood pressure at home for improving treatment continuation rate, evaluating the effectiveness of antihypertensive medications on decreasing blood pressure, and determining an effective treatment plan [
A survey was conducted with patients with hypertension treated at an outpatient clinic to examine their understanding of the disease and self-management behavior. When considering the association between understanding of the disease, self-management behavior, and basic attributes, participants who reported that they understood the disease and the need to achieve their target blood pressure tended to exhibit more self-management behaviors, including measuring blood pressure at home, visiting physicians regularly, and consulting with physicians and nurses. In addition, participants who had a spouse and lived with their family had a higher rate of understanding the need to achieve their target blood pressure. Measuring and recording blood pressure are the most important self-management behaviors. To maintain appropriate self-management, it is essential that patients have an optimal understanding of the disease and self-management behaviors, and they receive support from their family. Therefore, the present findings emphasize the importance of the role of nurses, in cooperation with physicians, in providing patient education to improve their understanding of the disease and self-management, and including their families in discussions as much as possible.
The author is grateful to the patients who cooperated in this research and the doctors of the Department of Cardiologyat Tokyo Medical University Hospital.
The author declares no conflicts of interest regarding the publication of this paper.
Igarashi, R. (2019) Status of Understanding of the Disease and Self-Management Behavior among Patients with Hypertension. Health, 11, 905-923. https://doi.org/10.4236/health.2019.117073